In California, a revised Bloodborne Pathogen (BBP) standard, mandating that health care facilities use needle safety products, becomes effective July 1, 1999. This provides an excellent opportunity to evaluate the impact of the standard with the following specific aims: 1) to assess facility compliance as measured by the BBP Standard Compliance Checklist, as well as barriers to and facilitators of compliance; 2) to determine the number of needlesticks in health care facilities for the years 1998-2001; 3) to assess employee perceptions of workplace safety as measured by the Safety Climate Measure for health care and to determine the relationship between safety climate and compliance; and 4) to determine facility costs before and after adoption of this standard. Methods: The investigators will randomly select 225 hospitals, home health agencies, and skilled nursing facilities for participation. Surveyors will assess compliance by auditing administrative and work practices, engineering controls, and written documents. Barriers to and facilitators of compliance will be assessed through interviews consisting of semi-structured, open-ended questions. Employees of participating facilities will be surveyed regarding their perception of workplace safety, and the relationship between facility compliance and safety climate will be determined. The financial implications of the standard will be estimated by comparing facility costs two-years prior to and subsequent to the intervention. Long-term objectives: Intervention research is an important and underutilized research tool in occupational safety and health. Health care workers, employers, and policy makers need data to understand the various outcomes of standards designed to protect workers.